Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia: An angioplasty model

Daniel B. Fram, Rabih R. Azar, Alan W. Ahlberg, Linda Gillam, Joseph F. Mitchel, Francis J. Kiernan, Jeffrey A. Hirst, Jeffrey F. Mather, Edward Ficaro, Gizelle Cyr, David Waters, Gary V. Heller

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: This study was designed to determine how long nuclear myocardial perfusion imaging (MPI) remains abnormal following transient myocardial ischemia. BACKGROUND: Acute rest MPI identifies myocardial ischemia with a high sensitivity when the radionuclide is injected during chest pain. However, the sensitivity of this technique is uncertain when the radionuclide is injected following the resolution of symptoms. METHODS: Forty patients undergoing successful coronary angioplasty were randomized into four equal groups. Tc-99m sestamibi was injected intravenously during the last balloon inflation (acute MPI) in 30 patients and then reinjected 1, 2, or 3 h later (delayed MPI). In a fourth group, the radiopharmaceutical was injected at 15 min following balloon deflation (delayed MPI). A final injection was performed at 24 to 48 h (late MPI) in 37 patients (93%). RESULTS: A perfusion defect was detected in all 30 acute MPI studies; in 7/10 patients (70%) injected at 15 min; in 11/30 patients (37%) injected at 1, 2, or 3 h; and in 7/37 patients (19%) injected at 24 to 48 h. Perfusion scores were 13.0 ± 9.2 on acute MPI, 5.1 ± 2.8 at 15 min (p < 0.001 vs. acute MPI); 2.6 ± 3.0 at 1, 2, and 3 h (p < 0.001 vs. acute MPI); and 1.3 ± 2.4 at 24 to 48 h (p < 0.001 vs, acute MPI; p < 0.03 vs. delayed MPI). CONCLUSIONS: Myocardial perfusion imaging may remain abnormal for several hours following transient myocardial ischemia even when normal flow is restored in the epicardial coronary artery.

Original languageEnglish (US)
Pages (from-to)452-459
Number of pages8
JournalJournal of the American College of Cardiology
Volume41
Issue number3
DOIs
StatePublished - Feb 5 2003
Externally publishedYes

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Myocardial Perfusion Imaging
Single-Photon Emission-Computed Tomography
Angioplasty
Ischemia
Myocardial Ischemia
Radioisotopes
Perfusion
Radiopharmaceuticals
Economic Inflation
Chest Pain
Coronary Vessels

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Fram, Daniel B. ; Azar, Rabih R. ; Ahlberg, Alan W. ; Gillam, Linda ; Mitchel, Joseph F. ; Kiernan, Francis J. ; Hirst, Jeffrey A. ; Mather, Jeffrey F. ; Ficaro, Edward ; Cyr, Gizelle ; Waters, David ; Heller, Gary V. / Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia : An angioplasty model. In: Journal of the American College of Cardiology. 2003 ; Vol. 41, No. 3. pp. 452-459.
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title = "Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia: An angioplasty model",
abstract = "OBJECTIVES: This study was designed to determine how long nuclear myocardial perfusion imaging (MPI) remains abnormal following transient myocardial ischemia. BACKGROUND: Acute rest MPI identifies myocardial ischemia with a high sensitivity when the radionuclide is injected during chest pain. However, the sensitivity of this technique is uncertain when the radionuclide is injected following the resolution of symptoms. METHODS: Forty patients undergoing successful coronary angioplasty were randomized into four equal groups. Tc-99m sestamibi was injected intravenously during the last balloon inflation (acute MPI) in 30 patients and then reinjected 1, 2, or 3 h later (delayed MPI). In a fourth group, the radiopharmaceutical was injected at 15 min following balloon deflation (delayed MPI). A final injection was performed at 24 to 48 h (late MPI) in 37 patients (93{\%}). RESULTS: A perfusion defect was detected in all 30 acute MPI studies; in 7/10 patients (70{\%}) injected at 15 min; in 11/30 patients (37{\%}) injected at 1, 2, or 3 h; and in 7/37 patients (19{\%}) injected at 24 to 48 h. Perfusion scores were 13.0 ± 9.2 on acute MPI, 5.1 ± 2.8 at 15 min (p < 0.001 vs. acute MPI); 2.6 ± 3.0 at 1, 2, and 3 h (p < 0.001 vs. acute MPI); and 1.3 ± 2.4 at 24 to 48 h (p < 0.001 vs, acute MPI; p < 0.03 vs. delayed MPI). CONCLUSIONS: Myocardial perfusion imaging may remain abnormal for several hours following transient myocardial ischemia even when normal flow is restored in the epicardial coronary artery.",
author = "Fram, {Daniel B.} and Azar, {Rabih R.} and Ahlberg, {Alan W.} and Linda Gillam and Mitchel, {Joseph F.} and Kiernan, {Francis J.} and Hirst, {Jeffrey A.} and Mather, {Jeffrey F.} and Edward Ficaro and Gizelle Cyr and David Waters and Heller, {Gary V.}",
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Fram, DB, Azar, RR, Ahlberg, AW, Gillam, L, Mitchel, JF, Kiernan, FJ, Hirst, JA, Mather, JF, Ficaro, E, Cyr, G, Waters, D & Heller, GV 2003, 'Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia: An angioplasty model', Journal of the American College of Cardiology, vol. 41, no. 3, pp. 452-459. https://doi.org/10.1016/S0735-1097(02)02766-3

Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia : An angioplasty model. / Fram, Daniel B.; Azar, Rabih R.; Ahlberg, Alan W.; Gillam, Linda; Mitchel, Joseph F.; Kiernan, Francis J.; Hirst, Jeffrey A.; Mather, Jeffrey F.; Ficaro, Edward; Cyr, Gizelle; Waters, David; Heller, Gary V.

In: Journal of the American College of Cardiology, Vol. 41, No. 3, 05.02.2003, p. 452-459.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia

T2 - An angioplasty model

AU - Fram, Daniel B.

AU - Azar, Rabih R.

AU - Ahlberg, Alan W.

AU - Gillam, Linda

AU - Mitchel, Joseph F.

AU - Kiernan, Francis J.

AU - Hirst, Jeffrey A.

AU - Mather, Jeffrey F.

AU - Ficaro, Edward

AU - Cyr, Gizelle

AU - Waters, David

AU - Heller, Gary V.

PY - 2003/2/5

Y1 - 2003/2/5

N2 - OBJECTIVES: This study was designed to determine how long nuclear myocardial perfusion imaging (MPI) remains abnormal following transient myocardial ischemia. BACKGROUND: Acute rest MPI identifies myocardial ischemia with a high sensitivity when the radionuclide is injected during chest pain. However, the sensitivity of this technique is uncertain when the radionuclide is injected following the resolution of symptoms. METHODS: Forty patients undergoing successful coronary angioplasty were randomized into four equal groups. Tc-99m sestamibi was injected intravenously during the last balloon inflation (acute MPI) in 30 patients and then reinjected 1, 2, or 3 h later (delayed MPI). In a fourth group, the radiopharmaceutical was injected at 15 min following balloon deflation (delayed MPI). A final injection was performed at 24 to 48 h (late MPI) in 37 patients (93%). RESULTS: A perfusion defect was detected in all 30 acute MPI studies; in 7/10 patients (70%) injected at 15 min; in 11/30 patients (37%) injected at 1, 2, or 3 h; and in 7/37 patients (19%) injected at 24 to 48 h. Perfusion scores were 13.0 ± 9.2 on acute MPI, 5.1 ± 2.8 at 15 min (p < 0.001 vs. acute MPI); 2.6 ± 3.0 at 1, 2, and 3 h (p < 0.001 vs. acute MPI); and 1.3 ± 2.4 at 24 to 48 h (p < 0.001 vs, acute MPI; p < 0.03 vs. delayed MPI). CONCLUSIONS: Myocardial perfusion imaging may remain abnormal for several hours following transient myocardial ischemia even when normal flow is restored in the epicardial coronary artery.

AB - OBJECTIVES: This study was designed to determine how long nuclear myocardial perfusion imaging (MPI) remains abnormal following transient myocardial ischemia. BACKGROUND: Acute rest MPI identifies myocardial ischemia with a high sensitivity when the radionuclide is injected during chest pain. However, the sensitivity of this technique is uncertain when the radionuclide is injected following the resolution of symptoms. METHODS: Forty patients undergoing successful coronary angioplasty were randomized into four equal groups. Tc-99m sestamibi was injected intravenously during the last balloon inflation (acute MPI) in 30 patients and then reinjected 1, 2, or 3 h later (delayed MPI). In a fourth group, the radiopharmaceutical was injected at 15 min following balloon deflation (delayed MPI). A final injection was performed at 24 to 48 h (late MPI) in 37 patients (93%). RESULTS: A perfusion defect was detected in all 30 acute MPI studies; in 7/10 patients (70%) injected at 15 min; in 11/30 patients (37%) injected at 1, 2, or 3 h; and in 7/37 patients (19%) injected at 24 to 48 h. Perfusion scores were 13.0 ± 9.2 on acute MPI, 5.1 ± 2.8 at 15 min (p < 0.001 vs. acute MPI); 2.6 ± 3.0 at 1, 2, and 3 h (p < 0.001 vs. acute MPI); and 1.3 ± 2.4 at 24 to 48 h (p < 0.001 vs, acute MPI; p < 0.03 vs. delayed MPI). CONCLUSIONS: Myocardial perfusion imaging may remain abnormal for several hours following transient myocardial ischemia even when normal flow is restored in the epicardial coronary artery.

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DO - 10.1016/S0735-1097(02)02766-3

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